胆道閉鎖症術後胆管炎の対策 : 特に起炎菌の推定と抗生剤の選択について

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  • Estimation of Causative Organism and Selection of Antibiotics for Prevention and Treatment of Postoperative Ascending Cholangitis in Patients with Biliary Atresia

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The prevention and treatment of ascending cholangitis (AC) is an important factor during the postoperative period of biliary atresia, because reccurent cholangitis may not provide satisfactory porgnosis. The purpose of this study is to estimate causative organism and to select effective antibiotics for the prevention and treatment of AC. One hundred and twenty three patients with biliary atresia who experienced in our institution from 1970 to 1990 were subjected to this study. Bacterial flora was reviewed in bilioenteric conduit and blood culture with these patients, and sensitivity to antibiotics of bacterias in bilioenteric conduit at the time of ascending cholangitis were studied. Bacterias in bilioenteric conduit form 1970 to 1980, were revealed following results ; NFGNR (non fermentative gramnegative rods) 22.1%, Klebsiella 17.4%, E. coli 17.9% and Staphylococcus 3.1%. By the way, from 1981 to 1990, NFGNR 55. 1%, Klebsiella 20.5%, E. coli 5.4% and Staphylococcus 4.2% were detected. These frequency were similar to those at the time of AC and in blood culture. In blood culture positive 13 cases with recurrent AC, bacterias detected in blood were different in rate of 35% form those in bilioenteric conduit. The sensitivity to antibiotics of bacterias in bilioenteric conduit at the time of AC was effective such as following drugs ; Cefoxitin, Ceftizoxime, Latamoxef, Gentamicin, Amikacin, Ofloxacin and Imipenem/Cilastatin. This study has suggested : (l)the causative organism of AC was seemed to be due to mixed and opportunistic bacterial infection, (2) each of these organism could be found to occur AC,(3)the most effective selection of antibiotics was the combination of these drugs such as Latamoxef and Genetacin, or Imipenem/Cilastation and Amikacin.

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